Mental-health patients dying young

Affordable housing advocate Linda Chamberlain knows eight people with mental illness who have died recently. But she’s convinced it wasn’t mental-health issues that killed them.

“I can’t tell you how many people are dying at 40 from heart attacks due to diabetes and not proper nutrition,” says Chamberlain, 61, who leads workshops on exercise and healthy eating as a volunteer at the South Riverdale Community Health Centre. They’re not eating properly and they’re eating the wrong food,”

Chamberlain, who has schizophrenia and bipolar disorder, knows all too well how this can happen.

Ten years ago, when she was taking seven medications to combat mental illness, she suffered facial tics and tremors and was depressed, even suicidal. She weighed 180 pounds and had developed diabetes.

After slowly “going off the meds,” Chamberlain brought her weight down to 135 pounds, but she is concerned about her friends and acquaintances.

“Some of these medications are giving people diabetes,” she says.

Carol Zoulalian, director of member services for Houselink Communty Homes, a not-for-profit agency that provides housing for 420 people living with mental illness and their families, says 12 people in Houselink buildings died last year, all of them in their 40s. Nine died of natural causes. Some were taking medication for blood pressure or high cholesterol; others had cancer. All had mental illness.

She says other supportive housing agencies in Toronto have also experienced an increase in deaths among people who are at least 20 years younger than the average life expectancy. “Is this our new normal?” Zoulalian asks. “It’s really scary. It’s very sad.”

Studies have found that people with serious mental illness are at increased risk for cardiovascular disease and die on average 25 years younger than the general population.

Scot Purdon, a clinical neuropsychologist at Alberta Hospital Edmonton, recently review statistics on mortality for the Schizophrenia Society of Alberta, focusing at first on suicide rates, which are almost 13 times higher among people with serious mental illness than the general population. But he also noticed that people with serious mental illness were 1.79 times more likely to die of cardiovascular disease.

If you apply those rates to Statistics Canada mortality figures, people with serious mental illness account for the majority of suicides in Canada — 3,240 out of 3,512 annual deaths — but also a tremendous portion of people dying from cardiovascular disease, as much as 46,000 out of about 69,000 deaths. There many possible reasons for this, including weight gain caused by antipsychotic medication and lifestyle factors including smoking, lack of exercise and diet.

“Trying to find the cause of it is a big challenge,” says Purdon. “All of these things could come into play.” Over the last few years he has been collecting information on roughly 200 patients who had experienced a first episode of psychosis, often leading to schizophrenia, and were young and relatively healthy at their first appointment. At that time, only 10 per cent of the patients were considered obese, based on their waist circumference. Three years later, 40 per cent were.

The percentage of patients with abnormally high triglyceride levels also jumped from 10 to 60 per cent.

A 2009 study from Toronto’s Centre for Addiction and Mental Health found that people with schizophrenia had a significantly higher risk of cardiovascular disease than the general population.

Tony Cohn, lead psychiatrist of the mental health and metabolism program at CAMH, says “second generation” antipsychotic medications like Clozapine were introduced in the late 1990s to replace drugs that were found to have neurological side effects.

Cohn says young, new patients are most susceptible to weight gain, gaining on average 30 pounds within three to six months after starting treatment. He has seen people gain as much as 150 pounds.

But medication is only part of the story. Joan, 68, who manages her depression without medication, has diabetes and cardiovascular problems. She lives in a Houselink building, where many people have mental health issues and addictions, and knows how hard it can be to maintain a healthy diet on a low income. “When you have money in your hand, you don’t think of fruits and vegetables, you think of the addiction.”